Provider Demographics
NPI:1437522539
Name:WOLOBAH-KUYON, KORLU
Entity Type:Individual
Prefix:
First Name:KORLU
Middle Name:
Last Name:WOLOBAH-KUYON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KORLU
Other - Middle Name:WOLOBAH
Other - Last Name:KAMARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3739 CASTLE TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7836 OAKWOOD RD STE A
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4298
Practice Address - Country:US
Practice Address - Phone:410-768-6011
Practice Address - Fax:410-929-8180
Is Sole Proprietor?:No
Enumeration Date:2015-11-11
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR133750363LF0000X, 363LP0808X
VA0024178434363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily